Untreated depression can be fatal, just like untreated high blood pressure

Dr. Greg Ordway, Guest Commentary
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Aug 12, 2018 at 8:30 AM

Nearly 45,000 people die by suicide and over 1 million people attempt suicide each year in the U.S. Tragically, suicide is the second-leading cause of death in individuals between the ages of 10 and 34, and is even more common in older adults.

East Tennessee is profoundly affected by suicide, wherein several counties have some of the highest rates of suicide in the country. Most people have been emotionally damaged by the loss of a family member, co-worker or friend that has died by suicide.

Unfortunately, the rate of suicide in the U.S. is on the rise, despite attempts by numerous organizations to reverse this trend. Why do people commit suicide? The answer to this question is not simple.

Research has shown, perhaps not surprisingly, that stress and depression are leading contributors to suicidal behavior. Most people who die by suicide suffered from depression prior to their death.

The genes you received from your parents can raise your risk of depression and suicide, but genes only raise your risk somewhat and certainly do not dictate that you will get depression or die by suicide. Depression can be treated with drugs (antidepressants) and therapy.

Unfortunately, antidepressants are not always effective. In fact, antidepressant drugs are not fully effective for approximately 30 percent of people who suffer from depression. In our country, where over 15 million people are plagued with clinical depression each year, nearly 5 million individuals are unable to achieve wellness because of the failure of antidepressant drugs.

Antidepressants were discovered accidentally in the mid-1950s while researchers were searching for drugs for other medical purposes. Since then, nearly all old and new antidepressants work through the same primary actions.

Antidepressant drugs have become safer to use over this time, but they have not improved in terms of effectiveness. There has been great interest in the discovery of antidepressants with alternative actions that could treat those who do not respond to current drugs.

Recently, ketamine has been used successfully to treat patients that do not respond to traditional antidepressants, and it appears to act rapidly to alleviate depression and suicidal thoughts in depressed patients. But this drug has serious safety issues. Meanwhile, other researchers continue to search for better antidepressants.

At ETSU, my laboratory has spent many years searching for better ways to treat depression. Nearly two years ago, we discovered an enzyme that is over-expressed in the brains of individuals who suffered from depression at the time of death, and who had died by suicide.

It so happens that there are drugs on the market presently that inhibit this enzyme, but these drugs are used in the treatment of specific types of cancer. We tested representative drugs from this class of enzyme inhibitors in laboratory models that are used routinely to test drugs for antidepressant actions.

Remarkably, these enzyme inhibitors demonstrated antidepressant activity, and at least initially appear to work better than fluoxetine (Prozac), a commonly used antidepressant. We are very hopeful that, as we continue this line of research, our work will result in a better treatment for depression and ultimately reduce the incidence of suicide. But as we work hard for better treatments, we recognize that drug development is a slow and expensive process.

What can you do during the wait for the development of new and better antidepressants? Try to be aware of those in your social sphere who are suffering and offer your empathy and kindness. Provide them with information about where they can seek help. Be aware of the warning signs of suicide so that you can be an active agent to help prevent it.

The American Foundation for Suicide Prevention (www.AFSP.org) is an excellent source for this information, and for help. Through AFSP.org, you can also participate in activities dedicated to increasing awareness, providing support for suicide- prevention services and contributing to research to reduce depression and suicide.

If suicide is being considered, there is also emergency help at the National Suicide Prevention Lifeline (800-273-TALK).

If it is you who is suffering, you must realize that depression is a self-defeating illness that causes one to engage in behavior that makes depression more likely and more severe. Mild to moderate depression can be treated effectively with psychotherapy alone as an alternative to medication.

Untreated depression can be fatal, just like untreated high blood pressure. When you are depressed you typically reduce the very activities in your life that protect you from developing depression, such as exercise, social activities, eating the right foods and seeking help.

If while you are well you can maintain a regular exercise schedule, regularly socialize with family and friends, sleep adequately but not too much and eat a healthy diet, then you will decrease the chances that you will develop depression in the future. If your situation leads you spiraling into depression, then seek help from family, friends and your physician. The farther you get into depression, the harder it is to escape it.

Dr. Greg Ordway is a professor in East Tennessee State University’s Quillen College of Medicine. He has spent nearly 30 years studying the biology of depressive disorders in humans.